Research Of Relationship Between Refractory Inflammatory Bowel Disease And CMV,TNF-α

In recent years, incidences of inflammatory bowel disease(IBD) are gradually growing. As it grows, more and more patients are badly responsible to or non-responsible to traditional therapy. It is named refractory inflammatory bowel disease, when patients are badly responsible to standardized steroid or rebounding during dilution of charge or steroid-dependent and occurring adverse effect. It is reported that patients of inflammatory bowel disease with refractory or steroid-dependent are percent 30 to 60, much of whom are non-responsible to remedial measure such as azathioprine,6-mercaptopurine,cyclosporin A and tumor necrosis factor monoclonal antibody. How to deal with refractory inflammatory bowel disease becomes a difficult problem which clinician confront. The pathogen and nosogenesis of inflammatory bowel disease are still quite unclear, which closely relate to hereditary,circumstance,microorganism,immunity. Tumor necrosis factor plays an important role in nosogenesis of inflammatory bowel disease. In clinical, the serious gastrointestinal tract CMV disease commonly occurs in patients with immunosuppressive, however, it is hardly reported in persons with immunity-competent. At present, much more researchers believe that CMV infection is one of the reasons of refractory bowel disease.Objective:Inflammatory bowel disease include Crohn's disease and ulcerative colitis. Epidemiology's data show that incidence of inflammatory bowel disease in at home and abroad is gradually increasing. More and more patients are badly responsible to or non-responsible to traditional therapy. How to deal with refractory bowel disease becomes a significant problem that clinician confronts. Based on this reason, we design this experiment to discuss the relationship between refractory inflammatory bowel disease and CMV to improve the cognition and level of therapy.Method:we collect seventy six patients with inflammatory bowel disease who are diagnosed in Tianjin general hospital from July 2000 to February 2009. All patients are diagnosed by clinical symptom,imaging examinations,colonoscopy and pathologic finding, which agree with diagnostic standard of inflammatory bowel disease. These patients are moderate to serious ulcerative colitis diagnosed by Truelove-Witts index. According to whether you use corticosteroid and the result of treatment, we divide these patients into effective group,refractory group and non-steroid group, which are compared with related clinical data of these group persons. We conduct immunohistochemical staining to colonic biopsy to observe incidence of CMV infection and expression of TNF-a.Result:(1)Patients with CMV-negative are totally sixty-five. In CMV-positive group, there are nine cases in refractory group,two cases in effective group and zero group in non-steroid group and differences between the three groups were significant. Patients with IBD who suffer from hot fever, cervical lymphadenopathy, splenomegaly are both in CMV-positive group. There is no difference between endoscope and pathological manifestations in refractory group,effective group and non-steroid group. Differences between pancolitis,left-sided,proctitis are significant. In this research, clinical manifestations are more various. Diarrhea and stomach ache are usual and two of these patients perform colectomy because of complication, which are both in CMV-positive group.(2)Patients with TNF-a negative are thirty-four. Patients with TNF-a are forty-two, which include twenty-one in refractory group, seventeen in effective group, five in non-steroid group. Difference between these three groups are significant(P<0.05). Patients with the steroid-refractory are eight in TNF-a positive group and Patients with the steroid-refractory are six in TNF-a negative group. Difference between two groups are significant (P<0.05).Conclusion:(1)Refractory bowel disease has a certain relationship with CMV. As the higher incidence of CMV is, the more serious the disease is. CMV infection can complicate the course of disease, occurring steroid-refractory. Whether antivirus therapy can improve the sensibility to steroid, it needs to further research. (2)The positive rate of TNF-a expression has a certain relationship with refractory bowel disease. It is higher in refractory bowel disease group.